Provider Demographics
NPI:1215392972
Name:JENKINS, LACY M (CRNA)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:M
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:M
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:DEPT 2607 PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-2607
Mailing Address - Country:US
Mailing Address - Phone:901-725-5846
Mailing Address - Fax:
Practice Address - Street 1:1755 KIRBY PKWY
Practice Address - Street 2:SUITE 330
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-8300
Practice Address - Country:US
Practice Address - Phone:901-725-5846
Practice Address - Fax:901-726-4827
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20599367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered